MEDICARE: JENNIFER DORREN LEONARD BEHAVIOR TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-18-55610	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790261709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DORREN LEONARD BEHAVIOR TECHNICIAN

Provider Business Mailing Address
First Line	:	2521 LINCOLN ST APT 102
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3957
Country	:	US
Telephone Number	:	786-757-9072
Fax Number	:

Provider Business Practice Location Address
First Line	:	2521 LINCOLN ST APT 102
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3957
Country	:	US
Telephone Number	:	786-757-9072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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